RESUMO
Although magnetic resonance imaging (MRI) data of patients with multiple myeloma (MM) are used to predict prognosis, few reports have applied artificial intelligence (AI) techniques for this purpose. We aimed to analyze whole-body diffusion-weighted MRI data using three-dimensional (3D) convolutional neural networks (CNNs) and Gradient-weighted Class Activation Mapping (Grad-CAM), an explainable AI, to predict prognosis and explore the factors involved in prediction. We retrospectively analyzed the MRI data of a total of 142 patients with MM obtained from two medical centers. We defined the occurrence of progressive disease after MRI evaluation within 12 months as a poor prognosis and constructed a 3D CNN-based deep learning model to predict prognosis. Images from 111 cases were used as the training and internal validation data; images from 31 cases were used as the external validation data. Internal validation of the AI model with stratified 5-fold cross-validation resulted in a significant difference in progression-free survival (PFS) between good and poor prognostic cases (2-year PFS, 91.2% versus [vs.] 61.1%, P = 0.0002). The AI model clearly stratified good and poor prognostic cases in the external validation cohort (2-year PFS, 92.9% vs. 55.6%, P = 0.004), with an area under the receiver operating characteristic curve of 0.804. According to Grad-CAM, the MRI signals of the spleen and bones of the vertebrae and pelvis contributed to prognosis prediction. This study is the first to show that image analysis of whole-body MRI using a 3D CNN without any other clinical data is effective in predicting the prognosis of patients with MM.
Assuntos
Aprendizado Profundo , Mieloma Múltiplo , Humanos , Inteligência Artificial , Mieloma Múltiplo/diagnóstico por imagem , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodosRESUMO
Castleman disease is a polyclonal lymphoproliferative disease which is clinically classified into unicentric (UCD) and multicentric (MCD). TAFRO syndrome is a relatively new concept that partly overlaps with MCD. Due to their rarity, their incidence remains unknown. This study investigated the incidence and prevalence of UCD, MCD, and TAFRO syndrome in Japan using a fixed-point observation method based on their incidence in Ishikawa prefecture. The annual incidences of MCD, UCD, and TAFRO syndrome in Japan were 309-731, 71-542, and 110-502, respectively, yielding annual incidence rates per million individuals of 2.4-5.8, 0.6-4.3, and 0.9-4.9, respectively, and nationwide prevalence of 4,180-14,900, 1,350-10,300, and 860-7,240, respectively. In conclusion, MCD, UCD and TAFRO syndrome may not be as rare as previously estimated in Japan.
Assuntos
Hiperplasia do Linfonodo Gigante/classificação , Hiperplasia do Linfonodo Gigante/epidemiologia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Prevalência , SíndromeRESUMO
A 48-year-old male underwent an osteosynthesis surgery for right patellar fracture without bleeding episodes around the surgery. After 7 months, he presented with a bleeding episode after a nail extraction surgery from his knee joint. He was diagnosed with mild hemophilia A after his second surgery. The patient's clinical course suggested that he had mild hemophilia A, although he had a past surgical history without any bleeding episodes. Early diagnosis is important in patients with mild hemophilia A because bleeding episodes complicated with surgery can be prevented by the administration of prophylactic replacement therapy.
Assuntos
Hemofilia A/diagnóstico , Joelho/cirurgia , Hemorragia Pós-Operatória/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Lymphoproliferative disorders (LPDs) are generally caused by uncontrolled B-cell proliferation induced by the Epstein-Barr virus (EBV) in the setting of impaired EBV-specific T-cell immunity, particularly when there is pharmacological immunosuppression including antithymocyte globulin. We herein present an unusual case of EBV associated with LPD (EBV-LPD) in which LPD occurred 3 weeks after the use of rabbit antithymocyte globulin administered for severe hepatitis-associated aplastic anemia; the patient died of fulminant leukemic lymphoma 5 days after the onset. We also review the pertinent literature on EBV-LPD after immunosuppressive therapy and document the efficacy of EBV viral load monitoring and the need for preemptive therapy.
Assuntos
Anemia Aplástica/virologia , Soro Antilinfocitário/efeitos adversos , Infecções por Vírus Epstein-Barr/complicações , Linfoma Difuso de Grandes Células B/virologia , Transtornos Linfoproliferativos/virologia , Acidose Láctica/etiologia , Anemia Aplástica/tratamento farmacológico , Animais , Soro Antilinfocitário/uso terapêutico , Ciclosporina/uso terapêutico , DNA Viral/sangue , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Coelhos , Carga ViralRESUMO
A 79-year-old female patient with multiple myeloma who had no prior cardiac disease history developed an acute myocardial infarction on day 5 after receiving bortezomib and dexamethasone (BD). After treatment of coronary stenoses by stents, she received another course of BD therapy and developed angina pectoris on day 5 after the therapy. Bortezomib's antitumor effect is due to the inhibition of proteasome activity. This inhibition may increase endothelial progenitor cell apoptosis and decrease endothelial nitric oxide synthase/nitric oxide (eNOS/NO), thus leading to coronary spasm. It is, therefore, important to carefully monitor patients being treated with bortezomib for the potential occurrence of ischemic heart disease.
Assuntos
Antineoplásicos/efeitos adversos , Ácidos Borônicos/efeitos adversos , Dexametasona/efeitos adversos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico , Infarto do Miocárdio/induzido quimicamente , Pirazinas/efeitos adversos , Idoso , Bortezomib , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/patologia , Feminino , HumanosAssuntos
Plexo Braquial/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Nervo Sural/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnósticoRESUMO
Human leukocyte antigen (HLA)-mismatched stem cell transplantation from non-inherited maternal antigen (NIMA)-complementary donors is known to produce stable engraftment without inducing severe graft-versus-host disease (GVHD). We treated two patients with acute myeloid leukemia (AML) and one patient with severe aplastic anemia (SAA) with HLA-mismatched stem cell transplantation (SCT) from NIMA-complementary donors (NIMA-mismatched SCT). The presence of donor and recipient-derived blood cells in the peripheral blood of recipient (donor microchimerism) and donor was documented respectively by amplifying NIMA-derived DNA in two of the three patients. Graft rejection occurred in the SAA patient who was conditioned with a fludarabine-based regimen. Grade III and grade IV acute GVHD developed in patients with AML on day 8 and day 11 respectively, and became a direct cause of death in one patient. The findings suggest that intensive conditioning and immunosuppression after stem cell transplantation are needed in NIMA-mismatched SCT even if donor and recipient microchimerisms is detectable in the donor and recipient before SCT.
Assuntos
Anemia Aplástica/cirurgia , Crise Blástica/cirurgia , Quimera/imunologia , Rejeição de Enxerto/imunologia , Doença Enxerto-Hospedeiro/imunologia , Antígenos HLA/genética , Imunidade Materno-Adquirida , Leucemia Mielogênica Crônica BCR-ABL Positiva/cirurgia , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Doadores de Tecidos , Condicionamento Pré-Transplante/métodos , Doença Aguda , Adolescente , Adulto , Anemia Aplástica/imunologia , Anemia Aplástica/patologia , Crise Blástica/imunologia , Crise Blástica/patologia , Quimera/genética , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Progressão da Doença , Evolução Fatal , Feminino , Rejeição de Enxerto/genética , Doença Enxerto-Hospedeiro/genética , Doença Enxerto-Hospedeiro/prevenção & controle , Antígenos HLA/imunologia , Histocompatibilidade , Humanos , Isoantígenos/imunologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/imunologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mieloide/tratamento farmacológico , Leucemia Mieloide/patologia , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Indução de Remissão , Irmãos , Vidarabina/administração & dosagem , Vidarabina/análogos & derivadosRESUMO
We report a case of refractory peripheral T-cell lymphoma (PTCL) successfully treated with a combination of fludarabine and cyclophosphamide (FLU/CY). A 68-year-old man with concurrent PTCL and diffuse large B-cell lymphoma was treated effectively with 3-course CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy, but PTCL relapse occurred and was resistant to ESHAP (etoposide, methylprednisolone, cytarabine, and cisplatin) therapy. FLU/CY therapy led to complete remission, which was maintained for almost 14 months after a single course. We concluded that a FLU/CY regimen may be useful for attaining long-term remission in patients with refractory relapsed PTCL and should therefore be considered a valuable treatment choice.
Assuntos
Ciclofosfamida/administração & dosagem , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma de Células T Periférico/tratamento farmacológico , Segunda Neoplasia Primária/tratamento farmacológico , Vidarabina/análogos & derivados , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cisplatino/administração & dosagem , Citarabina/administração & dosagem , Doxorrubicina/administração & dosagem , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Etoposídeo/administração & dosagem , Humanos , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Linfoma de Células T Periférico/patologia , Masculino , Metilprednisolona/administração & dosagem , Segunda Neoplasia Primária/patologia , Prednisona/administração & dosagem , Recidiva , Indução de Remissão , Fatores de Tempo , Vidarabina/administração & dosagem , Vincristina/administração & dosagemRESUMO
To identify candidate antigens in aplastic anemia (AA), we screened proteins derived from a leukemia cell line with serum of an AA patient and identified diazepam-binding inhibitor-related protein 1 (DRS-1). Enzyme-linked immunosorbent assay (ELISA) revealed high titers of anti-DRS-1 antibodies (DRS-1 Abs) in 27 (38.0%) of 71 AA patients displaying increased paroxysmal nocturnal hemoglobinuria (PNH)-type cells (PNH(+)), 2 (6.3%) of 32 PNH(-) AA patients, 5 (38.5%) of 13 PNH(+) myelodysplastic syndrome (MDS) patients, and none of 42 PNH(-) MDS patients. DRS-1 gene was abundantly expressed in myeloid leukemia cell lines and in CD34(+) cells derived from healthy individuals. Stimulation of T cells from an AA patient displaying high DRS-1 Abs with a putative CD4(+) T-cell epitope (amino acid residues [aa's] 191-204) presented by HLA-DR15, which overlapped with a hot spot (aa's 173-198) of DRS-1 Ab epitopes, gave rise to T cells cytotoxic for L cells (murine fibroblasts) that were transfected with DRB1*1501 and DRS-1. Enzyme-linked immunospot assay demonstrated increased frequency of T-cell precursors specific to the DRS-1 peptide in other HLA-DR15(+) AA patients displaying high DRS-1 Ab titers. These findings indicate that DRS-1 may serve as an autoantigen eliciting immune attack against hematopoietic stem cells in a subset of AA patients characterized by increased PNH-type cells.